Americans spend more on health care than anyone else in the world, and obesity is a significant cause of the high cost of care.

“Shame and blame” — shorthand for strategies like higher taxes and public stigma that worked to cut the incidence of smoking — are being used to fight America’s fat problem. New York wants to tax big sodas. Some companies charge obese employees higher insurance premiums.

Obesity can lead to at least 20 different chronic diseases. Patients with multiple chronic illnesses like diabetes, sleep apnea, arthritis and heart and circulatory weaknesses account for the largest share of health spending.

Everyone has an instinctive sense of what’s wrong when obesity is the problem: too many calories consumed, too few calories sweated out.

Some companies are requiring employees to get their biometrics done every year, including their body mass index, which is what most commonly defines a person as overweight or obese. Two-thirds of Texans already weigh more than they should. As companies try to curb the high cost of health insurance, they are pointing obese employees at wellness programs.

Many already charge employees more for their health insurance if they smoke. Some have started charging obese employees more as well.

If keeping obese employees healthy costs more, it follows that they should bear more of the burden — just as smokers do.

“We really don’t know how to treat a toddler like that,” said Dr. Jon Oden, a pediatric endocrinologist at Children’s Medical Center. “There really isn’t much on the table apart from getting control of their diet. … The drug company vendors wouldn’t even talk to us about medications.”

Oden is medical director of the hospital’s Coach Clinic for overweight and obese kids. The clinic started in 2005 and is getting new referrals at a rate of 2,000 a year.

“Shame and blame does not provide lasting results,” Oden said.

“It’s a very, very complex issue. It’s not simply that we eat too much and we don’t exercise enough. That’s a huge part of the problem. But we need to educate families on how to deal with infants. We need to educate pregnant mothers.”

Mothers who gain an excessive amount of weight during pregnancy or develop gestational diabetes are more likely to pass on to their infants weight problems and a tendency to develop diabetes that last throughout their lives, Oden said. And family responsibilities extend well beyond pregnancy.

“We have to focus on food providers, not just grocers but farmers and ranchers so we can come to an understanding about the economics of food,” Oden said. “And we can’t continue to have some sugary cereal with whole milk and chocolaty things for breakfast, a McDonald’s lunch and a big dinner at Chili’s and expect our kids to be healthy in 10 years.”

This will sound like common sense to many people. But if it is, it has not worked.

Ted Kyle, chairman of the Obesity Society’s advocacy committee, also cautions that “shame and blame” isn’t going to prevent or cure the problem.

“Over and over, what people say seems a deceptively simple problem is extraordinarily complex,” said Kyle, a Pittsburgh pharmacist. “What helps is to think health first and weight later. The goal should be helping everybody get to the best health they can. … Shame and blame doesn’t really work out too well. It pushes people away from health rather than toward it.”